A properly taken case is more than half cured, if this be possible by medical means, and a definite method should be followed, such as the one suggested.
The history should be taken in the regular manner and then expanded to meet the needs of our specialized therapeutics. Thus, following the history of the present illness, before the physical examination the patient’s subjective complaints are listed under four heads in regard to the four systems of the body. Interrogation under these give the indications for a pretty good Homoeopathic remedy as the chart indicates. See Appendix, Chart A.
We should question very closely here and not pass over with a perfunctory query, as they are useful diagnostically as well as material from which to cull Determinative symptoms. In cases where the history is already taken and where the only thing wanted is a Homoeopathic prescription chart “B” is suggested. This can readily be filled out at the bedside.
As in all history taking certain precautions are necessary :
1. Avoid asking leading questions and those that may be answered by “yes” or “no.”
2. Accept no diagnostic suggestions or pathological theories or former opinion of other physicians as these are deceptive guides for the selection of a drug.
3. Be sure to get the modalities.
4. Mood and mental state of the patient.
5. Notice any alternation of symptom groups, such as Bronchial symptoms, skin manifestations, gastric, and rheumatic complaints. Also seasonal and periodical variations.
6. Discount symptoms to be expected form the pathology obviously present. Thus, anxiety in heart disease-Paraesthesia in Anaemia-OEdema in Nephritis-Hunger in Thyroid and Gastric Ulcer- Depression in Constipation.
7. Note results of previous diet, local and physical treatment, for often the true symptomatology is obscured by previous treatment and a period of observation is desirable before Homoeopathic treatment is instigated.
Having made a provisional diagnosis and evaluated these symptoms, our next task is to underline in the history (or chart) those complaints which will aid us in selecting a Homoeopathic drug.
The next step is to assign each symptom to its proper column, basic or determinative, as provided for on the back of symptom chart “B”. The resulting list of symptoms should clearly picture that patient’s present condition. By reading these symptoms a physician, not acquainted with the case, should be able to classify the disease and suggest off-hand a group of drugs which would be capable of producing these basic symptoms.
To illustrate this, suppose we have a case of Pneumonia. Here the two classes might be as follows :
Restless and irritable
(<) Right side
(>) Cool air
Heart feels constricted
Cough (<) on back and warm room
By reading the basic group, certainly anyone acquainted with clinical medicine would picture a Pneumonia case, as these symptoms are standard. Anyone, even casually acquainted with Homoeopathic medicine, could suggest a group of four or five drugs which have all these basic or absolute symptoms. He gets this group usually from his knowledge of the pathological pathogenesis and elective affinity of the drug.
In the above case, Aconite, Bryonia, Phosphorus, and Iodine, all have the basic symptoms, but the question is which one of these four corresponds to the patient who has this disease-Pneumonia. In other words, what makes this Pneumonia different from any other pneumonia case? All have the basic symptoms (in more or less degree) and it is up to us to determine what constitutes this difference. That is why we have determinative symptoms – to determine a drug – finish the job.
We pointed out that the best way to get determinative symptoms was to inquire under four heads : mentals, modalities, common symptoms (qualified) and unusual or rare symptoms. Questioning the hypothetical patient under these four heads we learn that mentally he is irritable and restless.
As to modalities we observe that he is uncovered and constantly complains of the warm room. Also, he is worse at night and the right side is the involved one. Under the class ” common qualified symptoms” we have the symptom “headache,” but it is qualified because he says it is constricted-like a band. Cough is a common symptom in pneumonia, but this patient’s pneumonia case has a cough which is worse from a warm room and aggravated on his back, together with pain in the larynx.
Here, there are two “strange, rare, and particular” symptoms which have a deciding value in our selection. They are the constrictive feeling about the heart and the willingness to take food-the actual hunger of the patient which is certainly unusual in a febrile case and an unorthodox finding (and therefore valuable).
Now, checking these determinative symptoms against the known pathogenesis of Aconite, Bryonia, Phosphorus, and Iodine (by reference to the Materia Medica and repertory) we come to the conclusion that only Iodine has the majority of symptoms and is especially noted for the two unusual symptoms, the heart sensation and the appetite.
Such is one method of selecting the curative remedy. It is surprising once the symptoms are down on paper, how much easier the whole process becomes. All difficult cases would be tabulated in this manner and even at the bedside it is well to make a mental analysis of the two groups of symptoms, checking one against the other. Not every case shows all type of determinative symptoms, but it is good policy to keep in mind the little formula for their elicitation : “Mentals, modalities, common symptoms and rare.”
Further points on case taking will be taken up under “bedside practice” in the next chapter.